Robotic radical nephrectomy for renal cell carcinoma: A systematic review
| Autor: | Giuseppe Vespasiani, Anastasios D. Asimakopoulos, B Iorio, Filippo Annino, Roberto Miano, Enrico Spera, R. Gaston, Salvatore Micali |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Urology Operative Time Blood Loss Surgical Nephrectomy Settore MED/24 - Urologia Robot-assisted laparoscopic radical nephrectomy Postoperative Complications Blood loss Renal cell carcinoma medicine Carcinoma Humans Hospital Costs Prospective cohort study Laparoscopy Carcinoma Renal Cell medicine.diagnostic_test Radical nephrectomy business.industry Open surgery Robotic radical nephrectomy General Medicine Robotics Length of Stay medicine.disease Kidney Neoplasms Robotic nephrectomy Reproductive Medicine Medicine (all) Operative time business Research Article |
| Zdroj: | BMC Urology |
| Popis: | Background Laparoscopic radical nephrectomy (LRN) is the actual gold-standard for the treatment of clinically localized renal cell carcinoma (RCC) (cT1-2 with no indications for nephron-sparing surgery). Limited evidence is currently available on the role of robotics in the field of radical nephrectomy. The aim of the current study was to provide a systematic review of the current evidence on the role of robotic radical nephrectomy (RRN) and to analyze the comparative studies between RRN and open nephrectomy (ON)/LRN. Methods A Medline search was performed between 2000–2013 with the terms “robotic radical nephrectomy”, “robot-assisted laparoscopic nephrectomy”, “radical nephrectomy”. Six RRN case-series and four comparative studies between RRN and (ON)/pure or hand-assisted LRN were identified. Results Current literature produces a low level of evidence for RRN in the treatment of RCC, with only one prospective study available. Mean operative time (OT) ranges between 127.8-345 min, mean estimated blood loss (EBL) ranges between 100–273.6 ml, and mean hospital stay (HS) ranges between 1.2-4.3 days. The comparison between RRN and LRN showed no differences in the evaluated outcomes except for a longer OT for RRN as evidenced in two studies. Significantly higher direct costs and costs of the disposable instruments were also observed for RRN. The comparison between RRN and ON showed that ON is characterized by shorter OT but higher EBL, higher need of postoperative analgesics and longer HS. Conclusions No advantage of robotics over standard laparoscopy for the treatment of clinically localized RCC was evidenced. Promising preliminary results on oncologic efficacy of RRN have been published on the T3a-b disease. Fields of wider application of robotics should be researched where indications for open surgery still persist. |
| Databáze: | OpenAIRE |
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